Dr. Mitchell Shultz is board certified and a fellow of the American Academy of Ophthalmology, the American Society of Cataract and Refractive Surgery, the International Society of Refractive Surgery, and a member of CEDARS ASPENS. Dr. Shultz regularly conducts clinical studies as well as FDA-regulated investigations on the latest innovations in eye surgery. As one of the first surgeons in the United States to operate using the Stellaris Elite system, he has tremendous insight into the advantages of the vacuum-based phacoemulsification system.
Dr. Shultz noted that “When I first started using Stellaris, I was very impressed with how quickly the machine sets up for surgeons. It was very easy to get settings dialed in. When I started working on Stellaris Elite, I instantly noticed the ability to increase vacuum because Adaptive Fluidics™ technology significantly increased and maintained chamber stability during phaco.”2,3 Unfortunately, there are misconceptions about venturi-based systems. Today, venturi is adjustable, so the surgeon has linear control of the vacuum; vacuum is not all or nothing. Linear vacuum control makes it easy for surgeons to adapt, however surgeons need to get used to the lens fragments moving to the needle with a vacuum-based system such as Stellaris Elite rather than chasing fragments with a peristaltic system.
Stellaris Elite is the only phaco system that proactively monitors infusion pressure and automatically compensates for changes in pressure using Adaptive Fluidics technology to deliver exceptional chamber stability.2
As the surgeon starts to remove nuclear material on a flow-based phaco machine, there is a change in chamber stability and a post-occlusion surge can occur. With peristaltic systems, post-occlusion surges may occur. Specifically, after significant nuclear volume has been removed, there is a risk of the posterior capsule trampolining. With post-occlusion surge, there is an adjustment period where the chamber can shallow slightly as vacuum is still high, which can pull the capsule into the phaco needle. Dr. Shultz experienced several cases of post-occlusion surge in such patients with thicker nuclei using peristaltic machines. “Alternatively, with Stellaris Elite, I instantly noticed that Adaptive Fluidics significantly reduced surges and allowed for less stress on the bag compared to the Centurion, and we were able to increase vacuum for traditional cases from 430 up to 600 mmHg. The ability to utilize very high vacuum allowed for more efficient removal of cataracts to reduce total fluid utilization and phaco energy,” Dr. Shultz noted.
Stellaris Elite has a dual linear foot pedal that can be customized for the surgeon to adjust phaco and vacuum based on individual preferred settings. It was easy for Dr. Shultz to get used to the dual linear foot pedal and vacuum-based technology. With Stellaris Elite, as soon as the physician touches the pedal to increase vacuum in the vacuum-based system, pieces start to move to the tip. The surgeon is able to use vacuum on softer nuclei, without as much phaco power which helps to protect the endothelium and the capsule.
In Dr. Shultz’s experience, the feel and responsiveness of Stellaris Elite is similar to some of the other machines. However, with Stellaris Elite, the surgeon does not need to chase after pieces of the nuclei; the vacuum pulls pieces of nuclei to the middle of the eye. Consequently, there may be less risk of iris trauma and less risk of capsule trauma.
“For surgeons who want to continue to improve their skills as surgeons and want to incrementally improve efficiency, employing the latest technology is essential because it will cut down the amount of phaco energy used. As you become more proficient, you will have fewer risks of potential complications related to surge.”
– Dr. Mitchell Shultz, MD
To learn more about the Stellaris Elite System, please go to www.bauschsurgical.com/cataract/stellaris-elite. Connect with a representative today if you would like to hear more about how to demo the system in your OR.
Mitchell Shultz, MD is the Medical Director of Shultz Chang Vision in Los Angeles, California, and Co-Founder and Chief Medical Officer of Alchemy Vision Project. Dr. Shultz publishes articles on the most advanced technologies and techniques in laser refractive, cataract, and minimally invasive glaucoma surgery.
Financial disclosure: consultant to Bausch + Lomb